January 12, 2009	Monday	Muharram 14, 1430

PESHAWAR, Jan 11: The government has planned to involve lady health workers (LHWs) in the routine immunisation programme with a view to put brakes on the vaccine-preventable childhood ailments, officials said.

“In a nationwide campaign, Kohat, Karak, Haripur and Lakki Marwat districts in NWFP will get the services of 1,839 lady health workers,” an official said and added that under the programme 17,799 LHWs were being trained in the 38 districts throughout the country.

Under Microsoft giant Bill Gate’s Global Alliance for Vaccine and Immunisation (GAVI), $1.7 million would be spent on the training of the LHWs to improve the routine immunisation.

The three-year programme aims to improve the existing 50 per cent coverage of DPT and measles to 80 per cent.

The Expanded Programme on Immunisation (EPI) was launched in 1978 as continuation of the smallpox programme. Initially the EPI coverage among children was about 90 per cent which gradually dropped over a period of time. Recent studies have revealed that it was now between 47 to 60 per cent.

Health officials cited three main reasons for the decline. Shortage and inequitable distribution of human resources and limited outreach activities due to logistic problems and the most significant of these problems was reluctance of women in rural area and conservative communities in allowing male vaccinators due to socio-cultural taboos.

The LHWs programme was launched in 1994 with major objectives of reduction in maternal and infant mortality rates. The ministry of health approved a policy in 2001 whereby it allowed them to administer injections to pregnant women and millions of women were covered. In light of this success, the government has decided to involve them in the immunisation of eight immunisable diseases.

Under the EPI policy, strategic guidelines had been proposed for the role of LHWs in routine immunisation programme.

The health houses, already established at community level by the LHWs, would function as vaccination points for one day every month. The LHWs would be responsible for ensuring administration of vaccines to the target population and the report would be submitted to the EPI offices accordingly.

The LHWs would begin vaccination by administering tetanus toxoid (TT) vaccines the women of child-bearing ages independently and give other vaccines to the recipients initially under the supervision of vaccinators at static centres or during vaccination sessions at the health houses. They would start giving other antigens, first DPT and HB vaccines, then missiles and finally BCG vaccines independently.

The health houses would be provided with vaccines and disposable syringes, ice-boxes and other required materials by the vaccinators on need basis. An improved inventory tracking and forecasting system would be introduced.

Sources said that secretaries of health of all provinces and Gilgit-Baltistan to hold a joint meeting of stakeholders to develop consensus on broader outline of the programme and expansion of the programme in a phase-wised manner to other parts of the country.

The EPI targets about seven million children and 7.3 million pregnant women in the country. The involvement of LHWs could cover them in the health houses established elsewhere in the country.

The EPI faces the problems of poor vaccination coverage as well as high dropouts which has also become the source of embarrassment for the government and donor agencies.

The provincial coordinators of the LHW programme and EPI would be responsible for planning, monitoring and implementation of the collaborative activities. Both the programmes would undertake monitoring and supervision of the two programmes at district level jointly.

Officials said that with the involvement of LHWs in the EPI programme, the number of vaccinators would reach to 100,000.

The World Health Organisation had already signed a memorandum of understanding with the ministry of health to involve the LHWs in the programme. The world health agency is providing technical support to improve vaccination coverage through various interventions.